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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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CORNELISON, RAYMOND LOUIS JR       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: 8121 NATIONAL AVENUE
STE 402
OKLAHOMA CITY OK 73110

Address last updated on 5/6/2024
Phone #: (405) 321-5022
Fax #:
County: OKLAHOMA
License: 9074
Dated: 6/12/1968
Expires: 6/1/2025
License Type: Medical Doctor
Specialty: Dermatology
Dermatopathology
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: / 1968
CME Year: 2025
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications: AMERICAN BOARD OF DERMATOLOGY
AMERICAN BOARD OF DERMATOLOGY - Dermatopathology
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Aetna HMO
Aetna PPO
Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
BlueChoice PPO
BlueLincs HMO
CIGNA HMO
CIGNA PPO
CommunityCare HMO, Inc
Coventry Health Care National Network
First Health
HealthChoice
Heartland Health Plan of Oklahoma
Humana ChoiceCare
Humana Medicare Advantage PPO
Humana Tricare/PGBA
Medicare Blue
Oklahoma Health Network PPO
One Health Plan PPO
OSMA Health (formerly Plico PPO)
PacifiCare of Oklahoma, Inc
PHCS (Private Healthcare Systems)
Physicians Direct Network
PPO Oklahoma
PPO USA
Preferred Community Choice
Preferred Health Network-ppoNEXT
Prime Advantage Health Plan
Private Healthcare Systems (PHCS)
Prudential Health Care Plan, Inc
Railroad Medicare
Secure Horizons HMO
SoonerCare PPO
Tricare for Life
Tricare Standard
UniCare Health Plans of Oklahoma
United Healthcare Choice
United Healthcare HMO
United Healthcare Options PPO
Hospital Privileges: Mercy Hospital OKC
Oklahoma City, OK
Locations: Hours: Languages:
8121 NATIONAL AVENUE
STE 402
OKLAHOMA CITY OK 73110

Phone #: (405) 321-5022
Fax #:
Mon: 8:00AM - 4:00PM
Tue: 8:00AM - 4:00PM
Wed: 8:00AM - 4:00PM
Thu: 8:00AM - 4:00PM
Fri: 8:00AM - 5:00PM
Sat:
Sun: 8:00AM - 4:00PM
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
KELSEY JOY GLAZIER PA 3197
NICHOLAS ALBERT MIETUS PA 2854

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